<div class="layuimini-container">
    <form id="app-form" class="layui-form layuimini-form">

        <div class="layui-form-item">
            <label class="layui-form-label">适用门店名称</label>
            <div class="layui-input-block">
                <input type="text" name="store_title" class="layui-input" lay-verify="required" placeholder="请输入门店名称" value="">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">门店电话</label>
            <div class="layui-input-block">
                <input type="text" name="store_mobile" class="layui-input" lay-verify="required" placeholder="请输入门店电话" value="">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">使用时间</label>
            <div class="layui-input-block">
                <input type="text" name="store_date" data-date="" data-date-type="date" data-date-range="-" class="layui-input" lay-verify="required" placeholder="请选择使用时间" value="">
            </div>
        </div>

        <div class="layui-form-item layui-form-text">
            <label class="layui-form-label">搜索结果</label>
            <div class="layui-input-block" id="demo1">

            </div>
        </div>
        <div class="layui-form-item layui-form-text">
            <label class="layui-form-label">腾讯位置坐标</label>
            <div class="layui-input-block">
                <input type="text" name="store_str" disabled id="store_str" class="layui-input" lay-verify="required" placeholder="请选择搜索结果" value="">
                <tip>请选择搜索结果获取 腾讯位置坐标 “经纬度”</tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">详细地址</label>
            <div class="layui-input-block">
                <input type="text" name="store_name" class="layui-input" lay-verify="required" placeholder="请输入门店详细地址" value="">
            </div>
        </div>
        <div class="hr-line"></div>
        <div class="layui-form-item text-center">
            <button type="submit" class="layui-btn layui-btn-normal layui-btn-sm" lay-submit>确认</button>
            <button type="reset" class="layui-btn layui-btn-primary layui-btn-sm">重置</button>
        </div>

    </form>
</div>